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HomeMy WebLinkAboutSIMPSON ELECTRIC INC - INSURANCE CERTIFICATE (12)DATE (MM/DDiYYYY) ACORE) CERTIFICATE OF LIABILITY INSURANCE 4/3/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: RM LongmOnl TrueNorth Companies, L.C. PHONE - 275 S. Main St Suite 100 303-776-5122 (FAX,rNo:303-776.5495 Longmont CO 80501 —ADDRESS: long montsm truenorthcom anies.com INSURED Simpson Electric, Inc P. O. Box 2196 Loveland CO 80539 SIMPELE•01 INSURERS AFFORDING COVERAGE '` v NAIL # INSURER A: Owners Insurance Company 32700 INSURER B : Auto -Owners Insurance Company 18988 INSURERC: Pinnacol Assurance 41190 INSURER D : INSURER E : r1nv1=0AP_1ZC (11=13TIPICATF NI IURFR• 1'Y2)F,SRR59 REVISION NUMBER: T THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND_ CONDITIONS OF SUCH POLICIES. LIMITS_ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR r TYPE OF INSURANCE POLICY NUMBER _ �&� CY E F POLICY FXP LTR LIMBS A X COMMERCIAL GENERAL LIABILITY Y j 74144089 4/1/2019 4/1/2020 EACH OCCURRENCE $1,000,000 —• I-- CLAIMS -MADE OCCUR ` �7iTaAGE'12511ENT€.D.__.-._...- PR MI$E$_aP@_?9o;Erence ---- $300,000 MED EXP (Arly.onepersonL PERSONAL & ADV INJURY $10,000 $1,000,000 ` GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG — $ 2,000,000 X POLICY i` JP T LOC $ OTHER: A AUTOMOBILE LIABILITY 4268555900 4/1/2019 4/1/2020 COMBINED SINGLE LIMIT $1,000,000 __.� .._......_. _.__ -. BODILY INJURY (Per person) $— X.. ANY AUTO I OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED AUTOS ONLY X AUOT09 0NLDV BODILY INJURY (Per accident) _$ — - d9nJ MACE ;_(Per _-__..__ _ -- $ _$_ 8 X UMBRELLALIAB X OCCUR 4268565901 4/1/2019 4/1/2020 EACH OCCURRENCE $1,000,D00 EXCEE1SSSUUAB CLAIMS -MADE DED 1 X 1 RETENTION $ --non-- I AGGREGATE $1,000,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE 4182129 4/1/2019 4/1/2020 X PTAT EST E.L. EACH ACCIDENT $1.000,000 E.L. DISEAS_E.- EA EMPLOYEE — $1,000,000_ OFFICERIMEMBEREXCLUDED? (Mandatory In NH) NIA E.L. DISEASE - POLICY LIMIT _ $ 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below tt I I i DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If mote space is required) FICATE HOLDER City of Fort Collins Attn: Laurie P.O. Box 580 Fort Collins CO 80522 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE U 1988-2015 ACORD CUHPUHA I IUN. All rlgntS reserve0. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2' of 2 6431